Commissioning

The impact of immigration on the NHS has long been a contentious topic and the Queen's Speech last week, which outlined plans to restrict migrants' access to NHS care, has thrust it into the headlines once again. Yet hard data on the issue have sometimes been thin on the ground.

In 2011, the Nuffield Trust published an analysis that looked at how often international migrants to England use hospital care in comparison with English-born people.

To our knowledge,...

Even its best friends will grudgingly admit that information governance is not a topic that grabs you by the lapels and demands your attention.

That is, however, until some brave soul attempts to tweak the laws and directives around the use of data in the UK, at which point the issue suddenly becomes extremely interesting.

The latest intervention in this area, the most important for some years, comes from an independent working party headed up by Dame Fiona Caldicott (of the original...

The release today of a crucial report written by the Nuffield Trust, commissioned by the National Association of Primary Care (NAPC) sets out the challenges that face primary care and general practice.

In particular, the report looks at moving from a purely curative and reactive based approach to patient care, to one that is balanced against making significant inroads into the reduction of the rise in chronic ill health set against the backdrop of an ageing population.

As the NHS struggles to meet unprecedented financial efficiency...

This is a critical time for the NHS, with many key themes to discuss. But my start to the year is dominated by emergency care – a very practical challenge but one that raises important questions about culture too.

Across the NHS we are really struggling with emergency activity. Even allowing for Norovirus and prolonged cold weather we are experiencing unusual pressure.

The...

Our new series of interactive charts: The NHS in numbers pulls together some key data on health care spending, activity, resources and performance. These charts broadly cover the boom years for health care in the UK, from the late 1990s to the early 2010s, reflecting the latest data publicly available from official sources.

During this period, when Government spending on the NHS rose at the fastest rate experienced throughout its history, both public and private spending on health care increased year-...

Never in the field of NHS re-organisations can so many have left so few. Well, not literally. But April 1 sees some 160 NHS organisations, including all primary care trusts and strategic health authorities, abolished as hundreds more – 211 clinical commissioning groups plus a clutch of new national bodies and their regional arms – come formally into existence.

The result is what must be an unprecedented turnover of NHS chief executives. Some retiring, some moving on to other jobs, some taking redundancy, some leaving the direct employment of the service, some willingly, some not....

The Budget 2013 confirms that funding for health in England will be frozen in real terms for a further year – up to 2015-16 – and the requirement to under-spend allocations is here to stay. The Government has also extended the one per cent cap on pay awards for a further year and is talking about limiting pay progression.

This is hard for NHS workers but will be a big help to NHS organisations trying to match the money with the pressures on services.

After 2015-16 the Office for Budget Responsibility’s...

One of the most notable features about American health care is the use of fee-for-service as a payment model. In return for a consultation with a physician, outpatient procedure, or hospitalisation, the insurer (or the patient) pays for the individual services.

As fee-for-service operates on an individual service basis, the incentives for doctors to make more money are relatively straightforward – especially if a physician is the equivalent of a single-handed GP or private specialist – the more billable the activity, the higher the payment.

For example, given the choice between...

In a speech to the Nuffield Trust a few years ago, the then-Secretary of State for Health, Andrew Lansley, turned to the failings of care at Mid-Staffordshire to motivate his argument for reform.

In defending the cause of clinically-led commissioning, Lansley said: ‘where were the GPs? I’ll tell you: the GPs were there, they sent the patients to the hospital’ but too often they had a culture of ‘refer and forget’.

One of the questions asked by the Francis Inquiry has been: ‘where were the primary care...

For the third year running, we have carried out a small, snapshot survey of the NHS amongst the policy makers, senior managers, academics and clinicians who are attending our forthcoming Health Policy Summit, which takes place on 7 and 8 March.

This survey does not pretend to be representative in any way, but nevertheless provides a flavour of opinion amongst the 53 people who responded, in the wake of a year which has brought prolonged gloom about the prospects of improvement in the state of public finances and the passing and...

The Francis report has pushed money well down the pecking order as quality takes first, second and third place.

But as we come to the end of the financial year some eyes will again turn to how well the service is maintaining financial balance, meeting the Nicholson challenge of £20 billion savings and raising quality.

We know that the NHS needs to increase productivity to make savings, raise quality and balance the books. The consensus is that NHS productivity flat-lined over much of the last...

As clinical commissioning groups (CCGs) prepare for 1 April, one has to wonder how ready they really are to take full responsibility for local strategic planning and purchasing of health care.

The coming year will be one of immense challenge in terms of the quality and safety of health care, particularly in light of the Francis Inquiry’s call for a fundamental change in NHS culture.

And all of this at a time when NHS funding is flat and the NHS Commissioning...

The report of the public inquiry into Mid Staffordshire NHS Foundation Trust has focused our attention on the quality of care provided in hospitals.

The Inquiry was however about the wider NHS system and its ability or otherwise to spot and address failure. Indeed the list of witnesses to the Inquiry underlines the extent to which this wider system includes commissioners, regulators, policy-makers and local general practices.

Robert Francis' analysis of the events at Mid Staffordshire includes...

Health care reformers tend to focus attention on hospitals and payment systems and yet primary care, where most patients are seen, receives comparatively little attention.

While it is acknowledged that hospitals are now poorly suited to the different types of patients they have to treat, the fact that primary care faces similar problems is rarely acknowledged. The recent Nuffield Trust European Health Summit, supported by KPMG sought to redress this balance.

Across Europe, primary care is often characterised by small and isolated practices, with few...

There is almost universal agreement that the social care system needs urgent and fundamental reform. Despite this consensus the various attempts at reform over the last 20 years have all stalled.

Against that background Andrew Dilnot could have been considered either brave or foolhardy to accept the Government’s request to head the latest commission on reforming social care funding in 2010. Last year when it looked like the Government was planning to kick funding reform into the long-grass once again, the evidence pointed towards...

Amidst all the shocking evidence about failures of staff, regulators and managers, there's a subplot to the Mid Staffordshire Inquiry that's received less attention. This is the failure of the vehicles supposed to convey patients' voices beyond the hospital, to the local public, patient and representative bodies.

Evidence to the Inquiry exposed how the arrangements for responding to complaints within the hospitals failed to deliver: many patients complained to PALS (the Patient Advice and...

There is nothing like the New Year for compiling a 'to do' list, and nothing more satisfying than to start the list with some things you already have under way, so that you can tick a few off immediately. Last week the coalition Government gave us their version in the form of the Mid-Term Review.

The NHS chapter pulls together a series of previously announced service initiatives (e.g. rolling out telehealth and telecare, implementing a 'friends and family test'); details of their performance meeting targets and initiatives put...

Hospital mergers and reconfiguration are increasingly centre stage in the NHS. Several years of financial austerity, with more in prospect, is placing severe stress on hospital finances. The ability of hospitals to deliver the necessary annual cost reductions (in the order of five per cent per annum) through tactical savings schemes is fast diminishing.

Instead, more radical options for cost saving are being considered, including merger and major reconfiguration – as evidenced by the Department of Health’...

It's not as if we are not trying to reduce our need for emergency care. The past decade has seen a host of initiatives, innovations, policies and practices that should be helping to avoid the sort of health crises that lead to an emergency admission to hospital.

But have these worked? A recently published paper by the Nuffield Trust used a standard measure of health service performance to see what changes had occurred over the past decade.

The analysis looked at emergency hospital admissions for conditions where...

The current exam question for commissioners charged with ensuring the sustainability of the NHS is 'how can we make sure the NHS delivers integrated and sustainable services?', or as patients and their carers are more likely to describe it – 'who will make sure that we get properly joined-up care that will meet our needs going forwards?'

Providing integrated or joined-up care is an important challenge. However, it is not the only challenge and if effective co-ordination of care is to play a major role in sustaining the NHS, commissioners will also have to...